Research to Practice Gap: A Quantitative Exploration on Health Inequity in Substance Use Treatment Centers in California

Background: There is an ever-present research to practice gap when it comes to the implementation of evidenced-based interventions in substance use treatment. 1 out of every 10 people aged 12 and older struggle with a substance use disorder, but only 10% receive the treatment they need. Southern California is known as a “Rehab Riveria,” but not all treatment facilities are equal and equipped with evidence-based practices for the heterogenous populations they serve. We aimed to explore the treatment landscape in California by examining facilitates and if ownership, such as private for-profit, private non-profit, state government, local county, or community government, tribal government, or federal government were related to having tailored treatments.

Methods: The 2019 National Survey for Substance Abuse and Treatment Services (N-SSATS) data were used to explore treatment facilities in California. We examined associations between the ownership of the facility and the availability of EBIs such as tailored programs for opioids, women, older adults, LGBT clients, and veterans. Quantitative analysis included descriptive statistics and multivariate logistic regressions.

Results: A total of 1797 treatment facilities in California completed the survey, with 11% of the treatment facilities in the US being in California, the highest percentage of all states. In terms of ownership, 43% of facilities are private and for profit, 45% are private non-profit, .2% are state government owned, 8.3% are local, county, or community government owned, 1.2% tribal government owned, and 1.9% federal government owned. Only 8% of treatment centers offered an opioid treatment program and private non-profit ownership facilities were more likely to have an opioid treatment program (B=1.828, Wald=13.87, SE=.491, p<.001). 55.7% of facilities had a tailored program for women and ownership was not significantly associated. 30% of facilities offered tailored programs for older adults, with private for-profit organizations being the least likely to have them (B=-1.167, Wald=5.7, SE=.489, p=0.17). 32% had a tailored program for LGBT clients with private for-profit organizations being a predictor of not having them (B=-1.040, Wald=5.2, SE=.455, p=0.022). 28% had a tailored program for veterans, with private for-profit organizations (B=1.254, Wald=12.26, SE=.358, p<.001), private non-profit organizations (B=1.615, Wald=20.2, SE=.359, p<.001), and local, county, and community government ownership (B=2.503, Wald=33.8, SE=.431, p<.001), being associated with having such programs.

Conclusion: When it comes to treatment, no one size fits all and engaging with evidence-based treatment that is tailored for specific populations is important for best practice. This study found that, at most, 30% of substance use treatment facilities in California reported having tailored programs for populations such as people who use opioids, women, older adults, LGBT clients, and veterans. Many of these services were more likely to be offered at facilities that were private non-profit. This creates inequity in the service gap if tailored programs are not offered across the board where treatment may be more accessible for some. This research has implications on policy and requiring more tailored programs for specialized populations.